What to do if you have drug-resistant hypertension.

There’s an article making the rounds of the online PA community that I think breaks things down really well, and bears repeating here. It’s based on the research of  Dr. Wanpen Vongpatanasin, of the University of Texas, who seems to be doing some pretty groundbreaking stuff – for instance, focusing on race and gender differences. (In the past, much of the research about hypertension focused on males, over 55, and mostly white or African American.)
If I had seen this information, say, five or six years ago, my life right now might be very, very different. This is a great checklist to bring to a primary care doctor if you’ve been diagnosed with hypertension and the typical meds they push these days – beta blockers, calcium-channel blockers, and ARBs – do not work for you. I’ve copied the main points directly from the article; my comments are in red.
  • Get tested for aldosterone. The starting point is a blood test that specifically checks your aldosterone level. If this test establishes that there is a problem, you will need to do a 24-hour urine catch to determine more precisely how high your aldosterone level is. This is called a salt-loading test because you consume a lot of dietary salt for five days beforehand. Why? Excess dietary salt normally shuts down aldosterone production, but this doesn’t happen in people who produce too much of the hormone. As a result, people with this problem tend to retain excess sodium. (Aldosterone level alone is not sufficient – they also need to check plasma renin activity and determine the aldosterone-renin ratio. And the salt loading test, as those of you who have been following me know, only requires three days of sodium loading and can be done via meds instead of diet – quicker, more controlled.)
  • Have a CT scan to learn whether you have an adrenal tumor. For reasons unknown, tumors on the adrenal gland trigger a hyperactive mode for aldosterone production. Ninety percent of the time, these tumors are benign and surgical removal of them solves the problem. Malignancies, of course, may require more complex treatment. (The statistics I’ve been given show that 90% of the time the tumors are benign, but the success rate of surgery is closer to 60-75%. Variables include other health problems, and how long the patient’s blood pressure has been uncontrolled.)
  • Consider whether you need medications to control aldosterone. In people who don’t have a tumor, the drug spironolactone (Aldactone), which blocks aldosterone from its receptors in the brain and the kidney, is useful, says Dr. Vongpatanasin, noting that it’s also helpful for those with a tumor who aren’t candidates for surgical removal. (Additionally, there is another drug, eplerenone, which also goes by the brand name Inspra, that works with fewer side effects. There is no generic, and it is expensive, and most insurance companies will not cover it without a preapproval process. But spironolactone has some really extreme side effects in some,, so it’s good to be aware that there is another option – I’m one of these people, and I’ll address this in a future post.)
  • Reduce dietary sodium, and increase fruits and vegetables in your diet. Cutting sodium helps bring aldosterone levels back in line. For most people, the general guideline for salt intake is now about one teaspoon per day, according to the National Institute of Medicine, but for those who are more sensitive (including people who have high aldosterone), the recommended upper limit should be no more than half that amount. And Dr. Vongpatanasin’s research shows that while people who live in places without lots of processed foods have high aldosterone levels at the same rate as the rest of the world, they don’t tend to develop elevated blood pressure. It’s likely that the lower sodium intake from their fresh- and whole-food diets deters hypertension. (I’m a huge skeptic when it comes to conventional Western medicine’s dietary cure-alls – for instance, the government-recommended 9-11 servings of grain a day would make me sick as a dog and big as a house! – but this one makes sense. Except for one thing – I’ve never been a huge eater of processed foods, and I’ve been salt-averse since childhood, and I still developed the dang tumor. But the takeaway message – put the processed foods back on the shelf, eat real food, and don’t add salt – is one that applies to everybody who is interested in being in optimal health.)

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